The World Alliance for Breastfeeding Action (WABA) is a global network of individuals
& organisations concerned with the protection, promotion & support of breastfeeding worldwide.
WABA action is based on the Innocenti Declaration, the Ten Links for Nurturing the Future and the
Global Strategy for Infant & Young Child Feeding. WABA is in consultative status with UNICEF & an NGO
in Special Consultative Status with the Economic and Social Council of the United Nations (ECOSOC).

Health Care Issues

Complementary Feeding

Complementary feeding is the term used for giving other foods and drinks in addition to breastfeeding after the completion of the 6 months exclusive breastfeeding period. The food and drink given should “complement” or make complete - the energy and nutrition provided by continued frequent breastfeeding up to two years and beyond. In other words, complementary foods are needed to fill the gap between the total nutritional needs of a child and the amounts provided by breastmilk.

Inadequate nutritional quality, or the baby is given complementary food too early or too late, in too small amounts, or not frequently enough are some common challenges that mothers or caretakers face when introducing complementary food to children 6-24 months old.

The feeding pattern in the first two years of life has tremendous impact on the individual, household and society as a whole. Poor infant feeding patterns often lead to malnutrition. Malnutrition occurring in the first two years of life is virtually irreversible and impairs:

1. Cognitive development
2. Intelligence and school performance
3. Physical strength, and stamina
4. Productivity of a nation

Between 6-24 months children grow rapidly and their energy, vitamin and mineral requirements increase, but their stomachs are still relatively small (30ml/kg body weight – about the size of a cup). Throughout this period, children need highly nutritious foods, which provide a lot of nutrients in a small quantity of food. Below is a guidance chart on the quality, frequency and amount of food to offer children 6-24 months of age who are breastfed on demand:

Introducing Solid Food into a Breastfed Infant’s Diet

Age

Texture

Frequency

Amount at Each Meal

Percentage of Calories From Breastmilk

Approximate Calories From Complementary Foods

0-6 months

-

> 8 times per day

-

100%

-

6 - 8 months

Start with thick porridge, well mashed foods

Continue with mashed family foods (vegetable, meat, fruit)

2-3 times per day plus frequent breastfeeds

Depending on the child’s appetite, 1-2 snacks may be offered

Start with 2-3 tablespoonfuls per feed, increasing gradually to 1/2 of a 250 ml cup

70%

200 kcal

9 - 11 months

Finely chopped or mashed foods, and foods that baby can pick-up

3-4 meals plus breastfeeds

Depending on the child’s appetite, 1-2 snacks may be offered

1/2 of a 250 ml cup/bowl

55%

300 kcal

12 - 23 months

Family foods, chopped or mashed if necessary

3-4 meals plus 1-2 snacks between meals plus breastfeeds

Depending on the child’s appetite, 1-2 snacks may be offered

3/4 to full 250 ml cup/bowl

40%

550 kcal

Source: WHO

It takes time for a young child to learn how to use his/her lips to clear food off the spoon, and how to move the new food to the back of the mouth, ready for swallowing. Some food may run down the chin, or be spat out. The health workers should tell the families that this dose not mean that the child dislike the food. With encouragement and patience, a child soon learns how to eat new foods and enjoy new tastes.

The Guiding principles for complementary feeding of the breastfed child, summarised in the box below, set standards for developing locally appropriate feeding recommendations. They provide guidance on desired feeding behaviours as well as on the amount, consistency, frequency, energy density and nutrient content of foods.

Guiding principles for complementary feeding of the breastfed child

1. Practise exclusive breastfeeding from birth to 6 months of age, and introduce complementary foods at 6 months of age (180 days) while continuing to breastfeed.

2. Continue frequent, on-demand breastfeeding until 2 years of age or beyond.

5. Start at 6 months of age with small amounts of food and increase the quantity as the child gets older, while maintaining frequent breastfeeding.

6. Gradually increase food consistency and variety as the infant grows older, adapting to the infant’s requirements and abilities.

7. Increase the number of times that the child is fed complementary foods as the child gets older.

8. Feed a variety of nutrient-rich foods to ensure that all nutrient needs are met.

9. Use fortified complementary foods or vitamin-mineral supplements for the infant, as needed

10. Increase fluid intake during illness, including more frequent breastfeeding, and encourage the child to eat soft, favourite foods. After illness, give food more often than usual and encourage the child to eat more.

Resources, Useful Research and Links

WABA

Breastfeeding Gateway: Breastfeeding beyond 6 months Internationally agreed recommendations for optimal feeding of infants and young children advocate exclusive breastfeeding for the first six months of life, followed by complementary feeding and continued breastfeeding for up to two years or beyond. From 6 months, infants need additional foods alongside continued breastfeeding……………………..

2005 WBW Action Folder Breastfeeding and Family Foods: Loving & Healthy – Feeding other foods while breastfeeding is continued

Guiding Principles for Complementary Feeding of the Breastfed Child Adequate nutrition during infancy and early childhood is fundamental to the development of each child’s full human potential. It is well recognized that the period from birth to two years of age is a “critical window” for the promotion of optimal growth, health and behavioral development. Longitudinal studies have consistently shown that this is the peak age for growth faltering, deficiencies of certain micronutrients, and common childhood illnesses such as diarrhea. After a child reaches 2 years of age…….